Postnatal depression

While anyone who gives birth is vulnerable, there are certain factors that increase the chances of developing postnatal depression.

Risk factors before pregnancy and birth:

• Past history of depression or other mental health problem(s).
• Relationship difficulties, especially with the father of the baby or with own mother.
• Having little social support.
• Onset of depression during pregnancy.
• Hormonal problems.
• Life stresses or difficulties such as money or housing problems.

Risk factors related to the birth:

• Birth complications, such as caesarean delivery can lead to experiencing ‘birth trauma’.
• The birth did not live up to expectations, e.g, birth in hospital or with medical intervention
• when the person wanted a home or natural birth.
• Baby has health problems, including damage caused by birth

Risk factors after birth:

• Ongoing postnatal blues.
• The mother experiences sleep problems.
• The baby is fussy, has problems feeding, or has colic or reflux.

• Feeling low, sad or depressed.  You might feel sad or empty, you might not feel anything at all. You might experience pain that’s hard to describe or locate. You may cry for no apparent reason. Some people feel sad or low all the time, others have periods where they feel better that do not last longer than a day or two. People from non-European cultures might have different words to describe this feeling. If you’re Māori, you might think of it as feeling wainuku (really low or down in the dumps), whākama (shame) or whākamaemae (emotional pain or distress).
• Losing interest and pleasure in usual activities. This means you don’t enjoy things you usually would. 
• Feeling irritable or angry for no reason. Some people find this is the main sign that something is wrong following childbirth. It can make dealing with the frustrations of caring for a young baby more difficult and can cause harm to other relationships.
• Change in sleeping patterns. The most common change is reduced sleep, with difficulty getting to sleep, disturbed sleep, and/or waking early and being unable to return to sleep. While it is usual for new parents to have their sleep interrupted by a waking baby, people with postnatal depression often find they cannot sleep even when the baby is settled. You may lie awake worrying about the next feed or the next day.
• Not feeling connected to baby or feeling overly anxious about baby. Some people experience both these things These feelings can cause whākama or shame and can mean some people are too ashamed to ask for help or share how they’re feeling. Understanding it’s a common part of experiencing postnatal depression and not a sign you’re a bad parent can be the first step toward recovery.
• Change in appetite, often not feeling like eating and, as a result, lose weight. Some people will have increased appetite, often without taking any pleasure in eating. 
• Decreased energy, tiredness and fatigue is common. You may feel that the smallest and simplest things are impossible. This makes caring for a baby more difficult.
• Physical slowing or agitation often comes with severe postnatal depression. You may sit in one place for periods and move, respond and talk very slowly; or you may be unable to sit still, pace and wring your hands.
• Feeling worthless or guilty involves loss of self-confidence, and this may make you withdraw from friends and whānau. You may also feel you’re a bad parent or doubt you can care for your baby.
• Having thoughts of hopelessness and death and feeling there is no hope in life. 
• Difficulty thinking clearly - you may have difficulty in concentrating or in making simple, everyday decisions.
• Feeling anxious – there are different kinds of anxiety you may be feeling.They may include:
  • Excessive worry or fear (often about your baby) sometimes with physical symptoms such as muscle tension, pounding heart or dry mouth.
  • Panic attacks, with sudden episodes of extreme anxiety and panic and physical symptoms of fear. Often this will involve panicking about your baby.
  • Phobias. Specific fears about situations, fear of open spaces, confined spaces, heights, objects, animals.
  • Excessive concern about physical health. You may worry you are physically ill in some way, or your baby is ill or has something terribly wrong with him/her.

Your doctor may prescribe you with antidepressants. Finding the right medication can be a matter of trial and error – there is no way to predict which medication will be effective and tolerated (have fewer troublesome side effects) by any one person.

If you are prescribed medication you are entitled to know:

• the names of the medicines
• what symptoms they are supposed to treat
• how long it will be before they take effect
•  how long you will have to take them for and what their side effects (short and long-term) are. 

The level of family/whānau support and involvement you need is up to you.

Family/whānau members may be struggling to know how to help. If there are specific things that would help you, try asking for them. Say: “it would be really helpful if you helped me fold the laundry/washed the dishes/hold the baby while I shower/take the other kids out for a bit.”

Remember it may be difficult and distressing for family/whānau and friends to see you feeling so low, and they may need to:

• Seek support for themselves from friends, family/whānau and/or counsellors.
• Educate themselves on postnatal depression.
• Get help with understanding what is happening to you.
• Learn to set clear boundaries about behaviour.
• Learn to manage their own stress.

Family/whānau can learn to use words that may help you feel supported:

• “You are not alone in this. I'm here for you”.
• “You may not believe it now, but the way you're feelings will change”.
• “I may not be able to understand exactly how you feel, but I care about you and want to help”.
• “You are important to me. Your life is important to me”.